Tuesday, October 24, 2023

 Article 125 References to New And Exciting Changes In Health Care 

LawenceRosierConsulting.blogspot.com Update 10/23/2023

Healthy Life Extension Longevity & Functional Medicine

 Dr. Peter Osborne

Youtube: Cure for Autoimmune disease discovered? Dr. Osborne”s Zone

Youtube: How to Fix High Blood Pressure

Youtube: How Gluten can Destroy your Brain and Nervous System

Dr. Mark Hyman

Youtube: Dementia,The Ketogenic Diet & Low Thyroid:Answering your questions

Youtube: Doctor Thinks he knows What Causes Altzheimers,Parkinson's and ALS. Dr. Jay Lombard

Dr. Sten Ekberg

Youtube: 3X Deadlier Than Cancer & Most People Don’t know They have it

Youtube: Top 10 Foods that Destroy your Heart

Youtube: 14 Common Insulin Resistance Treatments that stops your weight loss & may hurt you 

Youtube: Anti-Aging: The Secret to Aging in Reverse

Dr. Ken Berry

5 Foods That Will SPIKE Your Insulin - 2023

Dr. Dorothy Adamiak  

Youtube: Arterial Plaque Buildup Reversal (parts 1,2,3,4)

Dr Eric Berg 

What Happens If You Stop Eating Sugar for 14 Days – Dr. Berg On Quitting Sugar Cravings

Dr. David Perlmutter Book: Drop Acid 

Youtube: How Gut Bacteria Affects Blood Sugar with Dr. Momo Vuyisich & Dr. Casey Means

Youtube: The Deadly Truth about Uric Acid & How to lower Uric Acid Naturally

Youtube: The Impact of Glyphosate on our health 

Youtube: How To Enter Ketosis without Restrictive Diets

Dr Gabrielle Lyon

Youtube: Longevity: Start doing this to build Muscle & live longer

How to Stay Young, Smart and Fit Forever | Gabrielle Lyon on Health Theory

Youtube: Protein Truths and Myths: Does it cause Cancer and Aging? Stu Phillips PHD

DR.Thomas SeyFried Boston College

Youtube: Can a keto diet eliminate cancer growth? Dr. Thomas Seyfried says yes

Youtube: Shocking Truth About Cancer: Fix Your Diet & Lifestyle To Starve It For Longevity | Thomas Seyfried

Dr. David Sinclair PhD Harvard Med School Book: Lifespan 

Youtube: Groundbreaking Research on Anti-Aging: Unlock The Secrets to Longevity

Youtube: REVERSE AGING What to eat to increase Longevity, Dr. David Sinclair.

Dr. Richard Johnson & Dr. Rob Lustig

Youtube: Is Fructose a Driver of Altzheimer’s Disease

Youtube: Everything You NEED to Know About Fats! | Dr. Robert Lustig

Youtube: Metabolic Health Expert: The ROOT CAUSE of Insulin Resistance & How to FIX IT! | Dr. Robert Lustig

Dr. Steven Gundry  

Youtube: What you know about the Keto Diet is Wrong. This is what new studies are showing

Youtube: How to Enter Ketosis without Restrictive Diets - with Dr. Gundry 

Dr Alan Green on Rapamycin Rapamycin.news

Youtube: Rapamycin all you need to know & get started 

 Dr. Jessie Inchauspe & Thomas DeLauer

Youtube: 22 Most Dangerous Foods for high Blood Sugar

Dr. William Davis

Youtube: Microbiome Expert: Eat THESE FOODS to Heal Your Gut & AGE IN REVERSE | Dr. William Davis

Dr. Mike Hansen

Keto & MCT oil for Alzheimer’s One doctor’s family journey

Dr. Robert Lustig & Ben Grynol

Youtube: BIG FOOD, BIG SUGAR & How They Affect Our METABOLIC HEALTH Today | Dr. Robert Lustig & Ben Grynol

Saturday, August 26, 2023

Article 124: Proposed State Reforms For Longevity

 Lawrence Rosier Principal Consultant -Lawrence Rosier Consulting

12143 Cedar Grove Rd. Rolla Missouri 65401 573 426 2997 Twitter:@Rosier_Lawrence

 

Recent discoveries in healthcare by leading health care scientists is exposing the possibility of massive savings in a State’s Health Care expenditure. Breakthroughs in the area of preventing old age diseases such as cardiovascular heart attacks, cancer and many other age related infirmities are largely related to the American Diet, lack of Exercise. 


Example#1: Youtube: “REVERSE AGING: What to Eat to Increase Longevity, Dr. David Sinclair”. The US can save $2 to $3 trillion in old age health care, and $Billions can be saved  in each State by convincing the public that individual choices can increase longevity.


Example #2: Youtube: How to not die | Dr. David Sinclair. $Billions in old age healthcare can be saved in each state. If Life expectancy can be extended one year US savings is estimated to be $86 Trillion, to 10 years $365 Trillion.This can be achieved through Public education and the change to Functional Medicine.


Example #3: Using AI to generate personalized nutrition. Youtube: "How Gut bacteria affects Blood Sugar". With Dr. Vuyisich & Dr. Means.


Functional Medicine seeks to Prevent Disease rather than the current method of Treating Disease after it occurs.  This approach to health care emphasizes lifelong dietary nutritional, intense resistance exercise and intermittent fasting, resulting in the improvement in the health and longevity of the public. 


Individual Requirements to Achieve Longevity:

  1. Diet- what you eat and when you eat (intermittent fasting)

  2. Exercise -specifically Resistance training 3 times a week Minimum

  3. Proper Sleep

  4. Reduced Stress in the community and the environment

  5. Avoidance of Toxins

  6. Genetics Less than 20% (Can be modified- Dr. David Sinclair)


My recommendation to the State is to establish Wellness & Longevity Offices with Functional Medicine throughout the State.  This provides a means of educating the public to take responsibility for their health, preventing disease later in life. 


Besides public acceptance, these discoveries impact economically a wide range of our society from the Health Care industry to Agriculture (ref: the discovery that toxic herbicides and pesticides have entered our food chain).  The state should also enact new laws preventing the use of toxic herbicides and pesticides.  This will help to prevent the needless suffering followed by death and provide a long healthy life.


Friday, November 25, 2022

Article 123  A Simple Approach to Reforming US Health Care

By Lawrence Rosier Principal Consultant  

Reform of US Health care is difficult, some say impossible due to the many factions involved: social, political and economic.  As a management consultant I approach most difficulties by simply following the money but with health care there is also human responsibility.  This Proposal provides a pathway for reducing the cost of US health care and facilitates future reforms. 

As the American population ages a greater share of the health care cost is being shifted to a smaller workforce.  We are also living longer compounding the problem. The US Health Care Expenditure for 2020 was $4.1 trillion, 19.7% of GDP, (from National Health Expenditure) and is about double that of European systems (from Health System Tracker).  US Health Care inflation in 2020 was 9.7% (National Health Expenditure). The far reaching goal of this proposal is to reduce the cost of US health care by 25%, $1 trillion annually.

 

The bulk of a State’s health care expenses for low income and elder care comes from the State buying health care services from private Providers who are reimbursed from Medicare and Medicaid Programs. These two programs were found in some instances to have inflated procedural costs which benefit private Providers but not the public or the State.  For example a detailed analysis of the real costs of Cataract Surgery,  by Lawrence Rosier Consulting was found to be ten times less than that actually paid by Medicare to the Provider (see Article 110 of Lawrence Rosier Consulting blog).  Add to this massive fraud although not by all private Providers, and you have the reason for US health care being double that in Europe.

 

This Proposal is primarily directed at States. The process does not initially involve the Federal Government; if it did, legislation and debate would be required taking years to implement reforms in the US Health Care system. Current Funding by the Federal Government Is not affected.  Implementing States will save $billions from health care waste that can be used to self-finance the state’s expansion of its health care system by building or buying efficient clinics and hospitals. Each participating State will initially need to fund planning for the expansion of its Health Care System. The process will take a few years but the savings from waste will significantly increase from one $billion to several $billion per year depending on the size of the State and how aggressive it is.

 

I recommend that the State’s Health Care System be managed by the State’s University Teaching Hospitals, which can provide the expertise needed and keep political bias out of the system. The objective is to provide a statewide efficient uniform health care system bringing the best health care to all of its inhabitants at the least cost.

 

An example of what can go wrong is Haven Health Care, a not-for-profit entity created through a Joint Venture of Amazon, Berkshire Hathaway and JPMorgan Chase. Haven was following my blog recommendations but failed in 2021 (see Articles 7, 42, 117). The main reason for the failure was that Haven had to buy health care services from private Providers and did not invest in its own hospitals and clinics, leaving them paying high prices with none of the benefits. The three companies' employee base, 1.2 million, was spread throughout the US making it difficult to invest in their own local health care facilities. This Proposal provides a solution to this problem for Business and Industry saving them $billions in health care costs, by using State owned facilities and not private Providers.

 

The main advantage of this Proposal is that it uses the $2 trillion in health care waste to finance its own reform. The Proposal also avoids the Public's fear of reductions in Medicare and Medicaid. You can find detailed information on health care efficiency and government reform in the more than 120 articles at Lawrence Rosier Consulting blog.


About the author Lawrence Rosier.

1961, University Of Missouri Graduate Industrial Engineering.  1972, Western Washington State Honor Graduate Education.  1962, Employed by McDonnell Douglas doing Time Studies on the F4 Aircraft.  1969, Boeing Co. with a team that Certified the 747 Plane.  1975, Alexander Proudfoot Consulting, saved Clark Equipment $½ million (in 1975 dollars).  1981, McDonnell Douglas, Proposed reorganization of the Missile Systems Co. to Sandford McDonnell CEO, the proposal was implemented.  After retirement, started Lawrence Rosier Consulting.  Lawrence is in excellent health and continues his many activities including support for civic causes.  

 

Lawrence Rosier Principal Consultant  11/18/2022


Wednesday, December 5, 2018

Article 122. Rural Health Care Suggestions

 
For a large rural area I like to think of Rural Health Care as clusters of health care services provided by small hospitals and general clinics all located within a thirty mile perimeter. No one small hospital in the area can afford to provide the latest diagnostic equipment or has the doctors on staff to address all the needs of the community, but specialized hospitals can serve the needs of nearly all within the thirty mile perimeter. Currently small hospitals try to address as much of the health care needs of a rural community as it can afford. If the hospital board spends too much, the hospital will become insulvant and will have to close. By spreading the cost of health care services among the small hospitals health care services can be provided to all the community. By careful planning by the state specialized health care services can be located in surrounding clusters such that they are at a convenient distant for all rural residents.

A second approach to be considered is that of a medium sized hospital in a town population of 30,000 or larger. The hospital must be able to have the diagnostic equipment and have the Doctors on staff to address most health care situations. Within the thirty to fifty mile perimeter served by the hospital each small town should have the following Fire & Trauma Center. The design of the Fire & Trauma Center consists of a Fire house which also houses ambulances and a connected 24/7 small trauma center with a few beds and heliport for transporting patients to hospital facilities.

Small hospitals and larger hospitals all share the problem of rising health care costs which in many cases results in the seeking out of ways to charge Medicare and Medicaid as much as legally and in some cases illegally as possible. I call this our Fraud Based Health Care System. The solution to this problem is for the State to enter its own competing Health Care System into the health care market. The State may require that Medicaid patients use the State Health Care system where possible.

A second and important reason for doing this that improvements and cost saving in the current health care system become profit gains for private hospitals and are not shared with the state or the state's tax payers. For example in my Article 110. Design of a Cataract Surgery Clinic, the cost of the surgery could be reduced by 90%. These savings are taken as profits and are not shared with the State. This design assumes that 20 patients per day will provide the Clinic with enough patients to run a high patient volume/low cost clinic in an urban area, rural patients will have to travel to receive these services. At least 10 other similar high patient volume/low cost clinics could be designed for urban hospitals.

The problem for rural hospitals is how do you get these savings in rural hospitals where the number of patients may be only 2 or 3. the answer is you can't, but you can get a lot closer. In small hospitals and general clinics which specialize in certain procedures the number of patients available for outpatient procedures will be larger but still not large enough to operate like an urban clinic. The suggestion is for hospital staff is to do a particular outpatient procedure for a few available patients, then switch to a second procedure and then to a third procedure. The key to savings is the efficient switching of outpatient procedures. The savings is in the reduction in planning, training time and in the identification and collection of supplies. An efficient supply ordering system is required. Planning for switching to a procedure with the highest efficiency can be developed by the State and provided to rural hospitals.

In summary my recommendations are for the State to develop its own Health Care System so it can participate in the efficient savings I have recommended (see Article 113.). The State should also follow my Two Part Reform recommendations. Part 1. The implementation of Enterprise Lean and Part 2. The implementation of Daily Plans in the design of high volume/low cost Outpatient Procedure Clinics (see Articles 109-120). The State may want to reactivate small hospitals (closed for financial reasons) as a part of its new system and implement the above savings suggestions.


Saturday, July 14, 2018

Article 121. Enterprise Lean a Universal Tool and the Daily Plan

Enterprise Lean a Universal Tool and the Daily Plan

Lawrence Rosier Consulting
12143 Cedar Grove Rd. Rolla, Missouri 65401
573 426 2997

My two Part Reform  can bring significant improvement in nearly all working environments: Industry, Health Care, Research Labs, State and Federal Governments.   This Article concentrates on Enterprise Lean as the First Part of the reform.  The second part of the reform the development of the Daily Plan follows.

Enterprise Lean implements Lean Teams (developed by Toyota) to make continuous improvements to work processes and can be implemented almost entirely by existing  personnel. The Second Part develops a highly efficient Daily Plan for each repeating process using the Lean Team and a consultant.  

Part 1. Implementation of Enterprise Lean

The Concept of Enterprise Lean is a universal cure for what ever ails an organization.  The difference is in the rules set for the organization of the teams as you will see in the following examples:
1. Industry uses the Teams mostly on assembly lines for products.  The Teams solve production problems related to their work. Lean Teams can also work in the office.

2. Government Bureaucracies such as the massive Veterans Administration can be brought under Top Management control using Lean Teams.  The US Veterans Administration is known to be a highly toxic bureaucratic organization that the government has not been able to control. 

The implementation of Lean Teams by Office of  Inspector General (OIG)  Analysts provides a direct connection of the Lean Team to the Top Management OIG personnel.  This provides a back door connection to the VA management for solving problems at the work place (such as bullying and theft).  Lean Teams organized in this manner virtually eliminates many of the problems related to bureaucracies. This approach requires that the Teams select their leaders through secret ballot.  See Articles 92, 106 and 119.

3. Health Care can be greatly improved using Lean Teams because of the complicated environment of Patients and Procedures the teams can develop unique methods of solving problems.  The organization of the lean teams can be more flexible such as senior team members may be selected as the team leader.   See Articles 42 and 120.

4. Lean teams also work with professionals such as Research labs and other Scientific organizations.  Here again the Team organization is more flexible in the selection of the Team Leader.

Part 2. The Development of the Daily Plan

Most state government organizations: Washington State, Minnesota and Iowa only implement the Enterprise Lean portion of my Two Part Reform and as such overlook $millions in savings from the reorganization of repeating operations into Daily Plans.  ALL repeating operations can be reorganized into Daily Plans.

Lean Teams  provide the means for continuous improvement in all operations and are the best way to for them to be involved in the design of the Daily Plan for repeating operations.

The basic concept is to separate an entity's workforce into two main areas: Repeating operations and non-repeating operations.  Repeating operations are reorganized to get maximum efficiency which I call the Daily Plan. Non-Repeating operations hold the expertise for solving routine and non-routine operation problems.  They also provide backup services for the Repeating operations making sure that nothing interferes with their daily operations.

The best way to do this is to provide Consulting assistance to the Lean Teams of the Repeating operations.  The Lean Team provides the knowledge of how the current process works and working with the consultant the most efficient method can be made into the Daily Plan.  The expertise of the consultant is in being able to balance the work loads of the Team members so that no team Member waits on another to do his job. The Consultant breaks down the jobs and reapportions the jobs to each employee making them equal in time getting the highest efficiency possible.  The average savings is estimated to be a significant 60% of the existing unplanned work.  See Articles 110, 119 and 120.

Saturday, June 9, 2018

Article 120. Approach to a Two Part Health Care Reform

Approach to a Two Part Health Care Reform

Lawrence Rosier Consulting
12143 Cedar Grove Rd. Rolla, Missouri 65401
573 426 2997

My two Part Health Care Reform of hospitals can bring significant improvement in operations as well as an average of 60% savings in Routine Procedures.  The First Part of the reform implements Lean Teams (developed by Toyota) to make continuous improvements to Procedures and can be implemented almost entirely by existing Hospital personnel. The Second Part develops a highly efficient Daily Plan for each routine Procedure (requires a consultant).  Once the Daily Plan is developed it can be used in other hospitals. I have included a List of suggested Routine Procedures that can be used in Outpatient Clinics attached to a Hospital.

Part 1. Implementation of Lean Teams:

Consultant starts by working with clients Training Personnel to do the following:
1. Develop enterprise wide introduction plan
    Presentations to selected groups
2.  Determine the number of Facilitators needed
    Each Facilitator meets with about 10 Lean Teams
    Helping them get started: election of Team Leader (by secret
    Ballot) and how to work together to implement improvements. 

Part 2. Development of the Daily Plan

Consultant works with Lean Teams whose processes repeat on a daily basis in Health Care.

Daily Plan for Healthcare:
1. Make a list of all possible Routine Procedures.
2. Determine the number of Patients treated at this hospital location for each routine Procedure.
3. Estimate the number of Patients treated in the metro area for each routine Procedure. This determines the number of patients available or backlog.
4. Select first Procedure based on Highest number of Patients and the shortest time for a Surgeon to do the Procedure. Example: With Procedures requiring an hour of surgery time only 7 patients a day can be done.  While for Procedures requiring only a few minutes as many as 20  can be done per Day.  See Example Cataract Surgery with 90% Savings. Lawrence Rosier Consulting Blog Article 110.

The Consultant begins the design of the Daily Plan working with the selected Procedure Lean Team To do the following:
1. Make a cell phone video of the current operation of the selected procedure. 
2. The Number of Patients per day is determined by the length of time for the Surgeon to do the Procedure.
3. Balance the Patient Prep and Recovery time by nurses to the surgeon’s time allowing the Surgeon to do one surgery after another for the day. Review Cell phone video make sure that work load is distributed evenly among nurses so that no one is waiting on others to complete their jobs.
4. Document the Daily Plan.  After completion the Daily Plan can be implemented by other Lean Teams in other hospital locations.

Application to Metropolitan Hospitals

A state’s metro areas offers the biggest savings in Medicaid and in Medicare with a higher number of Patients the routine procedure Clinics can operate on a continuous daily basis.  If the number of patients in the backlog of a clinic is more than the clinic can manage a second duplicated clinic can be added to reduce the Patient backlog.

Application to Hospitals in Smaller Towns

Where Patient Backlog is not enough to support each Routine Clinic:
A Lean Team may have to develop as many as three routine Procedure Daily Plans and switch between them to maintain Patient backlog.  The Lean Team can do a particular routine Procedure for two weeks then switch to another Procedure for a week and then to the third Procedure.

State wide Health Care in Rural Areas

Suggested Small Town Health Care System
Small Clinics could be built in towns of about 10 thousand and about 25 miles apart.  The Clinics can be of the following design: They should be built adjacent to a fire station with ambulances. They will be 24-7 Emergency Clinics with a few over night beds and a helicopter port.  Some designs may have more beds.  Besides doctors and nurses this system depends on volunteers from within the community.

Besides an Emergency function the clinics can serve as place for state wide rural traveling Cataract Surgery teams to do Cataract Surgery.   The clinics can also service traveling Dialysis Vans for patients in remote rural areas.

Possible List of Routine Patient Testing and Procedures

Appendectomy
Cholecystectomy  (surgery to remove the gallbladder)
Dilation and Curettage (also called D & C) is a minor operation in which the cervix is dilated (expanded) so that the cervical canal and uterine lining can be scraped.
Hemorrhoidectomy (surgical removal of hemorrhoids)
Hysterectomy  (surgical removal of a woman's uterus)
Hysteroscopy (surgical procedure used to help diagnose and treat many uterine disorders)
Inguinal hernia repairs (protrusions of part of the intestine into the muscles of the groin.)
Prostatectomy (surgical removal of all or part of the prostate gland)
Tonsillectomy (surgical removal of one or both tonsils)


Common Surgical Procedures
According to the American Medical Association and the American College of Surgeons, some of the most common surgical operations performed in the United States include the above.
Excluded from this list is all cancer procedures considered to be too life threatening.
Excluded Heart surgery, Coronary artery bypass (bypass surgery) considered to be too life threatening.

Also excluded are procedures that vary significantly in time with different patients. Such as Releasing of peritoneal adhessions. (The peritoneum is a two-layered membrane that lines the wall of the abdominal cavity and covers abdominal organs. Sometimes, organs begin to adhere to the peritoneum, requiring surgery to detach them)

Sunday, May 20, 2018

Article 119. Simple two Part Reform can Achieve Massive Improvement in the VA


Simple two Part reform can Achieve Massive Improvement in the Veterans Administration.  The two part reform can be implemented almost entirely by existing VA personnel. The reform increases Management control, solves most of the VA's personnel problems and adds efficiency in Part Two saving $billions. I am available to answer any questions you may have about the reform call: LawrenceRosierConsulting (573) 426 2997.

Part 1. Continuous Improvement Teams

A simple two part reform can achieve a massive improvement in the Veterans Administration.  The first part is the implementation of Continuous Improvement Teams (CI Teams) throughout the VA in its hospitals and its offices.

History: CI Teams originally known as Lean Teams (aka Enterprise Lean) were first implemented by Toyota and adopted by nearly all Automotive MFG companies.  Now it has been implemented in Washington State, Minnesota and Iowa state Governments. It has also been implemented at the Cleveland Clinic.

Reason: The Veterans Administration is a large bureaucracy that is not easily managed by the Secretary of the VA especially for appointments from outside the VA by Presidents.  By implementing CI Teams throughout the VA the Mission for Continuous Improvement is given priority and a physical presence within the organization. Each team has a direct connection to VA's DC office where difficult problems can be solved.  Each Team is comprised of a working group both in hospital procedures and in VA offices. Team Leaders are elected by secret ballot and meet once a week or once a month to review and implement improvements to their work processes.

Part 2. The Daily Plan

The Second part of the reform implements what I call a Daily Plan by each CI Team whose basic processes do not change and are the same from day to day.  The CI Team with the help of a trained consultant creates a standard Daily Plan which can be duplicated in all VA areas where the same process is being done.

Development: Nearly all hospital Procedures undergo Planning and identification of which individual is going to do what job during the procedure.  The Daily Plan Standardizes this process and organizes it such a way that balances out each job such that jobs begin and end at the same time.  Thus no employee has to wait on another employee to finish his job. To achieve this the employee who has too much work will give some of his work to another employee that has less work and balance the operation.  The result is a very highly efficient operation that when operated continuously with a higher volume of patients in a hospital environment can increase the average efficiency by 60%.

Summary: This simple implementation throughout the VA will attain maximum efficiency.


Suggestions for implementing Reforms in the VA

 

Overview of Approach to Reforming Veterans Affairs.

The standard Government and Industry approach which I have developed can be used for implementing Reforms in the VA.  This approach first implements Continuous Improvement Teams (Enterprise Lean) facilitated by OIG Analysts.  As a part of Enterprise Lean's basic function of continuous improvement, Daily Plans are produced by the CI Teams doing repeated processes..  This activity is aided by OIG Analysts acting as Facilitators.

Reorganizing for the Implementation of Reforms

This approach taps into special expertise of the VA OIG organization retraining OIG Analysts to be the primary implementers of the VA reform process.  Using Government Personnel (OIG Analysts) instead of Outside Consultants, enhances the expertise of the OIG organization and will save $millions.  This approach will leave an ongoing OIG organization to maintain government management efficiency. Ref: Article 88. Lawrence Rosier Consulting Blog.

Pilot implementation 
Veterans Affairs Hospitals were selected as a likely pilot for starting the implementations of reforms. This will give a boost in helping Veterans needing healthcare and speedup Patient care through implementation of special patient throughput techniques.  Ref: Article 100. Lawrence Rosier Consulting Blog.

I suggest that the reforms be implemented first at the Hospital Facilities of the Washington DC Veterans Affairs Medical Center 50 Irving St NW, Washington, DC 20422

The Phases of the Reform Process

Implementation of Continuous Improvement Teams
The first phase is the implementation of Continuous improvement Teams. I suggest that OIG Analysts be trained as facilitators to guide each CI Team through the election of a leader process.

Implementation of the Daily Plan

OIG analysts will work with the CI Teams to get the highest efficiency and effectiveness possible in the Daily Plan.  OIG Analysts can use the data developed from the Daily Plans to develop bottoms-up budgets which identify the actual costs of all needed systems.  This is also the data needed to manage the organization’s work load and in the determination of staffing needed. Ref: Article 96. Lawrence Rosier Consulting Blog

A suggested simple approach is orient OIG Analysts as facilitators and immediately implement the selected VA hospital into CI Teams. The facilitators will then lead each team into building its Daily Plan.

Review of Lean Team Results and Collection of Lean Data

After a period of about two months most Functional Lean Teams, those that were organized and trained by OIG Analysts acting as Facilitators, should have their Daily Plans completed.  I suggest that some Functional Lean Teams with significant savings present their improved method to upper management.   The OIG Analyst will study the new method to document savings

Activities of the Reform Consultant

The Consultant will play a key role in being sure that the employee CI Teams are properly trained.  The Consultant will insure that the activities of OIG Analysts will be able to facilitate the implementation of CI Teams and will also aid in the development of daily plans.


Attaining a Balanced Work Flow

For Example: Lean specialists have made a Lean Study of a Cardiac Surgery Process and have made it more efficient saving the hospital thousands of dollars.  Since the study only looked at the surgery process it did not achieve its purported savings goals because it failed to include surrounding interfacing processes causing in-balance in the work flow.  If the lab supporting the surgery process was not also made efficient the Surgeon and his entire operating staff may end up waiting for lab results.

The Maximum Patient Throughput Method

The first activity is to determine the actual backlog of patients waiting for each specific hospital Procedure and select the most critical needed.

Individual employee Lean Teams (including Nurses) meet to determine the most effective way to do their Procedure in a Daily Plan.  The objective is to find the most effective and efficient way of doing the Procedure in a balanced work load environment. The Daily Plan is built around the Doctor or surgeon’s time in doing the Procedure for each patient.  This time determines how many patients can be done in a day.  The design of the Daily Plan may be repeated with another Doctor or surgeon to bring down the backlog.  

The Daily Plan arranges the processes in the order that they may be completed some in parallel with the Doctor’s time as key to obtaining the Maximum patient throughput Schedule.

The method also determines the equipment utilization of the process.  Besides determining the maximum throughput of patients the process also establishes a cost for labor and equipment depreciation and a budget for each Function.  The data can also be used to determine the exact increase in staffing and equipment needed to meet a desired patient appointment and processing schedule.  Support operations personnel are used to fill in when Team members are on vacation or absent.

Accurate Cost Data

With all innovation there exists a fundamental component, having accurate cost data for making the key decisions about which innovative proposals and adventures are cost effective.  Accurate cost data in most government operations including the VA simply does not exist. Yes; you will find cost data everywhere in government but not the kind of cost data I am referring to.  What you will find is after-the-fact cost data what was actually spent on the operation not what should have been spent by employing practices and innovation to get the highest efficiency with a balanced work load. The Development of a balanced work load in each medical procedure area is the key to determining the minimum staffing needed to meet patient appointment schedules.

Three levels of Throughput- Current, Capable and Required 

When we examine Patient Throughput we find that there are three levels of Throughput:
1. Current Throughput (number of patients processed in specific areas) determined by hospital records.
2. Capable Throughput determined by employee Lean Team studies and a Throughput Schedule using current staffing.
3.  Required level of throughput to bring down high Patient backlog levels.  This is arrived at by expanding the Capable Throughput Schedule adding staffing until the Required level is reached to satisfy appointment schedules.

How this process can be implemented

The problem: determine waiting Veterans Health Care Needs and the added impact on VA hospital capabilities followed by the increased staffing to meet requirements.

If the original Capable Throughput Schedule is expanded each time a Doctor is added we can determine the corresponding: number of nurses needed, equipment needed, and number of patients for a balanced work load.  Also with each step we can determine the added floor space required. Now we have the data needed for all VA Medical facilities by matching the increased patient load for each medical area to one of the balanced steps based on the number of doctors required yielding the patient load that meets the appointment schedule requirements.  This is not an estimate but an actual balanced work flow of doctors, nurses, and equipment for given patient load.

Before new computer VA Reporting systems can be built to estimate Staffing requirements at VA facilities there must be a solid footing of actual data to backup the new systems. The quicker this data is generated and proven the sooner computer systems can be developed.  The problem is that the data can be quickly generated within two months but the computer systems will take as much as a year to develop time that the VA does not have. Ref: Articles 54 & 55 Lawrence Rosier Consulting Blog.


References:

“In Search of Excellence-Lessons from America’s Best Run Companies” by Thomas J. Peters and Robert H. Waterman Jr., 1982.
“Innovation and Entrepreneurship- Practice and Principles” by Peter Drucker, 1985.
“Kaizen (Ky’zen) The Key to Japan’s Competitive Success” by Masaaki Imai 1986.
“Thriving on Chaos-Handbook for a Management Revolution” by Tom Peters, 1987.
“Attaining Manufacturing Excellence - Just In Time -Total Quality -Total People Involvement 1987”
By Robert W. Hall.
“American Business A Two Minute Warning” by C. Jackson Grayson, Jr. and Carla O’Dell 1988.
“Reinventing Government-How the Entrepreneurial Spirit is Transforming the Public Sector” by David Osborne and Ted Gaebler 1992.
“Banishing Bureaucracy-Five Strategies For Reinventing Government” by David Osborne and Peter Plastrik 1997.
“The Price of Government-Getting the Results We Need in an age of Permanent Fiscal Crisis” by David Osborne and Peter Hutchinson 2004.
“We Don't Make Widgets: Overcoming the Myths That Keep Government from Radically Improving”  by Ken Miller 2006.

Saturday, March 3, 2018

Article 118. Investigation highlights potential dangers of Surgery Centers


CBS "Investigation highlights potential dangers of surgery centers in the U.S." CBS News March 2, 2018.

A joint investigation by USA Today Network and Kaiser Health News highlights the dangerous conditions that have apparently led to many deaths in facilities known as surgery centers across the U.S. The report takes an in-depth look at operations performed at these non-hospital facilities and found more than 260 patients have died after surgery center procedures since 2013.  

The deaths occurred largely because the procedure wasn't done at a hospital, but at one of more than 5,600 surgery centers across the U.S. There are now more surgery centers, which focus on routine, same-day operations, than hospitals. The industry says this can make for cheaper, faster and more convenient service than in a hospital, but when something goes wrong during surgery, the hospital may be the safer option.

 It appears that others mostly individual Doctors have discovered, as I have, that General Hospitals are low patient volume/ high cost and that when routine procedures are moved to individual Surgery Centers the procedures become high patient volume/ low cost.  The problem found by this Investigation was that medical standards were not maintained and many of the Surgery Centers only objective was to make as much money as possible.

What’s happening here is: Insurance Companies, Medicare and Medicaid reimburse at the General Hospital rate leaving Surgery Centers to receive huge bonuses for each patient processed.

I recommend that all General Hospitals in metro areas reorganize creating routine specialized Surgery Centers (I have identified about 15) within the Hospital grounds with access to the Hospitals ER. 

This will reduce the cost of Health Care for: insurance Companies, Medicare and Medicaid. Unfortunately in rural areas where patient volume is low General hospitals will continue to provide services but at the current high rate. 

A related problem is that in metro areas with the conversion to internal independent routine Surgery Centers within each Hospital fewer Hospitals will be needed.

Sunday, February 4, 2018

Article 117. The Amazon, JPMorgan Chase, Berkshire Hathaway Consortium

The Amazon, JPMorgan Chase, Berkshire Hathaway Consortium

Three corporate giants: Amazon, Berkshire Hathaway and JP Morgan Chase have announced that they would form an independent health care company for their employees in the United States. This announcement signaled a possible massive change in the Nations Health Care causing Health Care stocks to plummet in the stock market. 

Our US fraud based private for-profit Health Care costs double that of Europe’s Government Health Care systems.  The Affordable Health Care Act provided health care for all but did almost nothing to reduce costs.  US Health Care is anything but affordable.

The Health Care Lobby in Congress has prevented reform in the nation’s health care.  A few years ago Lobbyists successfully got Congress to allow TV advertisements for Prescription Drugs now more money is spent by some drug companies on TV advertisements than on research boosting the cost of drugs.

State Governments are overwhelmed with healthcare overruns especially in Medicaid.  Now with US health care in near total disarray Corporate Giants are stepping in to provide health care for their employees and retirees.  They may then form alliances with State Governments to provide much needed change in health care.

My Health Care Suggestions have been adopted by the Consortium
General hospitals do nearly all Procedures with low patient volume and at high cost. The hospital design I am proposing is exactly the opposite: wholly independent routine Procedures are done in specialized Clinics with high patient volume at the lowest cost.  The Corporate Consortium can take advantage of this approach to reduce Health care costs for routine Procedures by as much as 60%.  Cataract surgery has been shown to reduce costs by 90%. Ref. Article 110.

Routine Procedure Clinic are completely independent and have their own staff and facilities.  Should the patient Volume be higher than that of the design the procedure can be redesigned or it can be duplicated with added staff and facilities. I have Identified about 15 possible clinics. Ref: Article 111.


Lean Teams develop Daily Plans
Enterprise Lean Teams developed by Toyota is currently being used in: Washington State, Iowa and Minnesota governments to make continuous improvements in State Government Functions. It has also been successfully implemented in the Cleveland Clinic well known for its health care.  The process consists of working teams that meet regularly to review and discuss how the work they are doing can be improved upon. Employees were found to become excited about their jobs with their involvement providing continuous innovative solutions to work problems.

For each Lean Team I have added the task of developing a Daily Plan for their Procedure.  Daily Plans are not easily constructed and will need help from trained professionals.

The Routine Procedure Clinics work Best with the following Criteria:
  • Repeatable Processes (relatively routine, process does not vary)
  • Sufficient Backlog for Continuous Operation  
  • Daily Plan efficiently designed by each Lean Team
  • Balanced Operations (no one waits for others to do their jobs)

In the future States may pursue the development of a State Health Care Delivery system as an alternative to the current private health care delivery system that is mainly driven by fraud.  The new system will require those who can, will pay for their own health care or provide their own insurance. The hope is that Corporate involvement in US Health Care reforms will migrate to a State government run non-profit system over the next 10 years similar to Europe but with better management controls.   $billions can be saved by eliminating waste in our Health care system.

The State of Missouri is following this recommendation when fully implemented will save the state $2 billion annually. 

Contact Lawrence Rosier
Lawrence Rosier Consulting
12143 Cedar Grove Rd.
Rolla, Missouri 65401
573 578 4716
lawrencerosier4@Gmail.com

Saturday, January 6, 2018

Article 116. Example of a Birthing Clinic

Example of a Birthing Clinic


This an example of a Birthing Clinic designed for efficiency it is a departure from other routine procedure clinics in that the patient is not free to chose when a baby is to be delivered in the Natural Birthing unit but in a Cesarean birth the time of the delivery can be planned.
The clinic is partitioned into the following completely separate Units:
1. Prenatal Care Unit (where patients and fetus are assessed before birth).
2. Natural Birthing Delivery Unit (most births).
3. Cesarean Delivery Unit
4. Natal Care Unit
5. Urgent Care Unit (for Fetal Delivery assistance and emergencies)

The prenatal Care Unit is where the delivery method is assessed Natural birth or Cesarean.  Special fetal problems are noted to be dealt with at birth.

The Natural Birth Delivery Unit has extra pre-staged delivery rooms for mothers awaiting birth.  Mothers awaiting delivery become a part of a triage where those requiring immediate delivery are delivered first. The Number of pre-staged delivery rooms is determined from historical data. The Natural delivery Unit will at times have extra unused facilities and staff but will be more efficient than most General Hospital births.

The Cesarean delivery Unit is largely a completely separate unit but Cesarean deliveries can be halted if doctors in the Natural Birth Unit become over-run. With an efficient Daily Plan Cesarean births can be done with considerable savings.

The Natal care unit would have the same capability as a General Hospital.

The Urgent Care Unit is available for to assist in difficult and multiple births (This is a small team with special skills).

A General Hospital may be converted to Birthing Clinic saving considerable investment costs over a new facility.

Contact Lawrence Rosier
Lawrence Rosier Consulting
12143 Cedar Grove Rd.
Rolla, Missouri 65401
573 578 4716
lawrencerosier4@Gmail.com